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What is revenue recovery and why did the City of Poquoson implement this program?

Revenue recovery is the process of obtaining financial reimbursement for the cost of providing medically necessary ambulance transportation. Medicaid, Medicare, and the majority of other private insurance policies (health, auto, and/or homeowners) allow for reimbursement for this service. As the need for additional emergency responders increases, local governments have sought ways to pay for these services without raising property taxes. Many other local governments in Virginia have found that billing Medicaid, Medicare and private insurance for ambulance transport service has resulted in a large amount of revenue being recovered to help defray the cost of the service. The availability of such revenues led the City of Poquoson to join the more than 40 cities, counties and towns in Virginia which currently have such a system.

Revenue recovery is the process of obtaining financial reimbursement for the cost of providing medically necessary ambulance transportation. Medicaid, Medicare, and the majority of other private insurance policies (health, auto, and/or homeowners) allow for reimbursement for this service. As the need for additional emergency responders increases, local governments have sought ways to pay for these services without raising property taxes. Many other local governments in Virginia have found that billing Medicaid, Medicare and private insurance for ambulance transport service has resulted in a large amount of revenue being recovered to help defray the cost of the service. The availability of such revenues led the City of Poquoson to join the more than 40 cities, counties and towns in Virginia which currently have such a system.

Our new billing company, EMS Management & Consultants, Inc. has customer service representatives to address your questions at 800-814-5339. If you are not satisfied with this response or wish to speak with someone locally, you can contact Poquoson Fire Administration at 757-868-3510 or email questions to Krista Corbitt.

In accordance with the Compassionate Billing Policy, the City's billing service will attempt to gain all information required to show the medical necessity of the transport. However, if the claim is ultimately rejected, the Department will consider the charge noncollectable for City residents. If this occurs with a non-city resident, it is the intent of the City to bill for those services to seek reimbursement. Again, residents and non-residents if qualified, may apply for the waiver.

Several billing vendors advised that this should not occur, as most if not all policies do not have a limit on emergency transports related to EMS service. If this does occur, pursuant to Poquoson's Compassionate Billing Policy, the additional fees would be waived.

There has been discussion among staff regarding an Office of Inspector General (OIG) opinion that surfaced last year. This opinion relates to the jurisdiction being able to use any taxes (real or personal property) to qualify as the co-pay for City residents. The City is utilizing the OIG opinion for its residents, so the out-of-pocket expense for the co-pay will be waived for City residents.

Ability to pay will NEVER be considered when providing service. Under the Compassionate Billing Policy, no one will suffer financial hardship as a result of a necessary emergency medical transport. When residents need emergency assistance, they should call 911 without hesitation. Most localities contacted, stated that call volume actually increased in some areas.

Some localities initially noticed a slight decrease in donations; however, within a couple of years the donations returned to pre-revenue recovery levels. Poquoson City Council has indicated that if the volunteer organizations have a reduction in donations, an appropriation would be considered to make up the deficit.

Several billing companies have indicated that many automobile insurance policies and homeowners' insurance policies provide some form of coverage if the insured was injured and required transport by ambulance. Billing companies routinely bill health insurance first, then auto, and lastly any other form of insurance.

The City of Poquoson contracts with a private company to handle the billing process. After patient care is provided, insurance information will be obtained routinely, often at the hospital. The City of Poquoson will waive co-payments and deductibles for City residents. Non-insured residents will receive an initial statement from the billing company, while insured residents will receive an explanation of benefits (EOB) from their insurance company. Non-insured residents may apply for the hardship waiver. Please refer to the Compassionate Billing Policy (PDF).